In March, Michael Osterholm ’75 published his second book, Deadliest Enemy: Our War against Killer Germs. If anyone is qualified to write about potential pandemics in the 21st century and what we can do to protect ourselves, it’s Osterholm. His credentials are staggering. He’s Regent Professor, McKnight Presidential Endowed Chair, and the founding director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He was the state epidemiologist at the Minnesota Department of Health for 24 years, and he’s served in various public health advisory capacities for the last four presidential administrations. He’s a frequent consultant to the World Health Organization, the National Institutes of Health (NIH), the Food and Drug Administration, the Department of Defense, and the Centers for Disease Control and Prevention (CDC). He’s served as an adviser on bioterrorism to the late King Hussein of Jordan and as special adviser to Health and Human Services secretary Tommy Thompson following the 2001 anthrax attacks. He’s a founding member of the National Science Advisory Board on Biosecurity and a member of the National Academy of Medicine and the Council of Foreign Affairs. This spring, Fortune magazine named him one of 34 leaders who are changing health care. We sat down in April to ask Osterholm about Deadliest Enemy and what every informed global citizen should know about infectious disease.
Luther Alumni Magazine: Why is infectious disease potentially the biggest threat to humanity in the 21st century?
Michael Osterholm: If people want to understand the global impact of an infectious disease, they should look no further than the
influenza pandemic of 1918. Over 100 million people died in 18 months—more than from all the major wars in the 20th century combined.
An influenza pandemic like that could happen tomorrow, particularly in light of the fact that right now, we have an influenza pandemic
in birds—in Asia, Africa, Europe, even the Americas. Every time one of these viruses is transmitted between birds, it’s a throw at the genetic roulette table for one of them to change such that it can become a virus transmitted to and by humans. That could happen tomorrow.Today, with three times as many people living in the world than lived in 1918, we could easily see hundreds of millions
of influenza-related deaths worldwide in just months. There is no other calamity that we know of that would essentially put us at this level of risk.
You make the point too that we’ve become a truly global society with complicated supply chains that would be really vulnerable in the event of a pandemic.
MO: People don’t realize how dependent we are on the entire world for the goods and services we use every day, including some that are
lifesaving. There are no walls tall enough, wide enough, or deep enough to eliminate infectious disease moving across borders, but there
are major deterrents for things that must move across borders for us to live our lives every day. For example, as we detail in the book, we did a study several years ago where we interviewed an internationally renowned group of doctors of pharmacy and asked what lifesaving drugs they have to have every day or people die. Not cancer drugs, not most antibiotics, surely not all the lifestyle drugs, but what’s actually on the crash cart in the emergency room? What are the drugs that if we don’t have this morning, we’ll have a death on our hands? We came up with 30 different drug categories. One hundred percent of them were generic, 100 percent were made offshore, 100 percent have no stockpiling anywhere—it’s a just-in-time manufacturing and delivery system. And if there were some hiccup anywhere in the world with regard to manufacturing, raw product availability, shipping, or delivery, we would see deaths. We actually today teeter on that. We’ve gone through periods with major shortages of these products, such as IV bags, when we don’t have a crisis.
Another global vulnerability we’re seeing relates to food supply. Today, to support the 7.4 billion people on the face of the earth, we obviously need protein. The fastest way to convert energy to protein and by far the most efficient is poultry. We’ve become a very
poultry–dependent world. For example, in any given month in Shanghai, about 125 million chickens are hatched just to feed the citizens
of Shanghai. Each one of these chickens is a virus test tube waiting to get infected. And so we now have a global issue with poultry where we need them badly to feed the world but they also amplify and potentially accelerate the risk of avian influenza like we’ve never seen before. Again, all of these modern-world situations in and of themselves are a problem, but when you put them together with an infectious disease, they become a life-defining issue.
Why is infectious disease a matter of national security?
MO: When Ebola was a major challenge for us in West Africa, I did a number of briefings for various congressional committees. And it
was interesting: the committees that had the most concern about the crisis were not the public health committees; they were the intelligence and military-related committees. Their concern was that if this epidemic continued to sweep eastward across central Africa and particularly into areas that were held by any number of dissident groups including ISIL, Boko Haram, etc., it would only further destabilize efforts that were being undertaken to try to neutralize these terrorist groups. They saw this as a huge threat.
Another major concern you address in the book is the rise of antibiotic resistance, for example with things like Methicillin-resistant Staphylococcus aureus (MRSA). Can you walk us through this threat?
MO: The evolution of microbial resistance dates back to the very first microorganisms. They competed for space and food, and they did that by producing chemicals called antibiotics that would kill or compete with other bacteria.
When we brought about the advent of the antibiotic era with new antibiotics for humans and animals, it was a godsend to infectious disease medicine and public health because now no longer did a routine cut or puncture necessarily potentially result in a life-threatening infection. The challenge is that what we’ve done is put our microbes on a hyperevolutionary course over the last 40 or 50 years by the tons of antibiotics we use each year. And today so much of that is unneeded and is just driving the evolution of this resistance. A bacteria, on average, reproduces every 20 minutes. When it does that, it often makes mistakes in copying its genetic material, and many of those mistakes or mutations are harmful to the bacteria and they die. But there are some new mistakes that end up being wonderful gifts to that bacteria because now they no longer need to have a certain chemical that an antibiotic attacks, so now they’re no longer vulnerable to that antibiotic.
And so we really have to understand that this is not one that’s a maybe; this is one that’s a yes. It’s happening. There was a comprehensive study completed last year in England called the AMR—we talk about it in the book. It concluded that by 2050, antibiotic-resistant infection deaths will surpass those from cancer and diabetes combined.
What can be done about it?
MO: First, we need to reign in the use of antibiotics. Second, we need new antibiotics, but the easy ones are all gone. And today, what
pharmaceutical company is going to invest hundreds of millions of dollars into what may not be a fruitful effort? And even if it is, we’re going to tell them: Don’t sell this thing unless you absolutely need to. And when you do sell it, make sure people take the least amount possible so they don’t develop resistance.
And so we don’t have the economic engine to drive new research and development of antibiotics, which we need. It comes down to government. Just as we strategically buy missiles and bullets, we should be funding this research. The third thing we need to do is look hard at novel ways to address antibiotic resistance. We need new vaccines for pathogens that right now are resistant; we have some in the pneumonia category, some in the diarrhea category. And we need new ways of looking at how to treat infections. This is work the Russians have been doing for some time, what we call phages—viruses that attack bacteria.
There are other ways to look at this; we are just taking a long, slow time to really understand it. In the book we highlight that and what can be done. This is not to scare people out of their wits—it’s to scare them into their wits. There’s a lot we can do about antibiotic resistance that we’re not doing.
How can politics support or undermine public health?
MO: I’ve been in this business now for 43 years. I have had advisory roles in the last four presidential administrations. As state epidemiologist in Minnesota, I worked for two Democratic governors, two Republican governors, and one independent wrestler, Jesse Ventura. And no one can tell you my partisan politics—I’m just another private in the army of public health, so take my comments in that context.
Public health and infectious diseases have not been partisan issues until now. What happened last summer in Washington, where funding for our emergency response to Zika was held hostage to politics, was unprecedented. I’d never seen that before—what happened with Zika was so politicized. And ironically the primary area hit is largely Republican, with a Republican governor, and it was a Republican Congress that refused to act.
I recently wrote a New York Times op-ed [“The Real Threat to National Security: Deadly Disease,” March 24, 2017] in which I talked about how the Trump administration is proposing major budget cuts to the NIH and the CDC as well as to groups like the USAID [U.S. Agency for International Development]—part of the State Department that has been a very important vehicle for us in dealing with international outbreaks. Tomorrow we could be sitting on top of an infectious disease right here in our own backyard, and we won’t be
prepared in the way that we could and should be.
I know we need to defend our country from a military and terrorism perspective, and I take that very seriously. But most people don’t ask the question: Why is it that we have spent more on military than the next seven countries of the world combined? So the question becomes how much is enough spending for the military, and how important is adding 54 billion new dollars to the military budget if you’re taking that away from public health preparedness? That’s when I make the argument that we’re penny wise and pound foolish. It will come back to bite us badly.
How do you stay encouraged?
MO: When I look at the future for my kids and grandkids, I don’t have any challenge at all in getting up in the morning and doing what I do. It’s their world. In the book, I talk about how my son was seriously ill with La Crosse encephalitis due to my own stupidity of watering my new lawn and not realizing I was also watering tree holes and creating an ideal breeding site for the virus-carrying mosquito. My kids and grandkids are just as vulnerable to these infectious diseases as anyone else.
I guess I also learned not to take no for an answer. I learned that at Luther. This is where my liberal arts education and scientific activism roots were first planted. I learned that right is right even if nobody’s right, and wrong is wrong even if everybody’s wrong. I look at the world as a place that my kids inhabit, your kids inhabit, the next generation inhabits, so we’ve got to do what we’ve got to do to make the world a safer and healthier place.
Osterholm gives first lecture in Roslien series
Osterholm was at Luther in April to deliver the inaugural lecture in the newly endowed Dr. David J. Roslien ’59 Distinguished Lecture in Science and Leadership. The lecture series, named for “Doc” Roslien, Luther professor of biology, vice president for college advancement, and interim president, brings to campus individuals who are internationally recognized for their contributions to science or for global
leadership in policy.
“To date, there’s never been a time when we more needed science and leadership in combination,” Osterholm says. “Science without good policy is just a bunch of people sitting around a table talking about their publications. Policy without science is often dangerous. What’s important is the merging of the two—and Doc’s career was all about that.”